Early Diagnostic Value Of Heparin-binding Protein And Neutrophil Gelatinase-associated Lipocalin In Sepsis-related Acute Kidney Injury

Objective:Acute kidney injury(AKI)caused by sepsis is very common in intensive care unit(ICU).The purpose of this study is to investigate the value of heparin binding protein(HBP)and neutrophil gelatinase-associated lipocalin(NGAL)in the early diagnosis of sepsis-related AKI,and to compare them with serum creatinine(s Cr),blood urea nitrogen(BUN),and to provide a more sensitive biological index for the early diagnosis of sepsis complicated with AKI.Methods:The data of patients with sepsis admitted to ICU of Bethune first Hospital of Jilin University from January 1,2020 to January 1,2021 were retrospectively analyzed.According to the occurrence of AKI within 24 h after admission,patients were divided into group A: sepsis with AKI group,and group B:sepsis without AKI group.At admission,the levels of HBP,NGAL,s Cr and BUN in group A and B were compared to determine the early predictive value of the above indexes in sepsis-related AKI.At the 24 h after admission,the levels of HBP,NGAL,s Cr and BUN in group A and B were compared.Then we analyzed the value of the above indexes in the early diagnosis of sepsis-related AKI.The sensitivity and specificity of HBP combined with NGAL,HBP,NGAL,s Cr,BUN in the diagnosis of sepsis-related AKI were evaluated by receiver operating characteristic curve(ROC).The correlations between HBP,NGAL and s Cr,BUN,PCT,Lac,D dimer,SOFA score and APACHE II score were also discussed.Result:(1)A total of 112 clinical cases were selected in this study,and 86 cases including 60 male patients and 26 female patients met the requirements.Among them,49 patients(AKI I:17 cases,AKI II: 13 cases,AKI III: 19 cases)were devided into group A,37 patients were devided into group B.There was no correlation between white blood cell count and C-reactive protein(CRP),age and sex(P > 0.05).(2)At admission,the levels of HBP and NGAL in group A were 102.10(85.85,137.90)ng/m L and 1097.00(940.50,1640.00)ug/m L,and in group B: the levels of HBP and NGAL were 51.90(37.50,59.90)ng/m L and 536.00(458.50,706.00)ug/m L,thus we found that the levels of above two indexes in group B were significantly lower than in group A.There was no significant difference in the levels of s Cr and BUN between the two groups.(3)At 24 h after admission,there was a significant positive correlation between HBP combined with NGAL,HBP,NGAL,s Cr,and AKI stage in group A,which was significantly higher than in group B,but the level of BUN had no significant correlation between AKI I and II stage,whereas it correlated closely with AKI III stage.(4)Analysis of receiver operating characteristic curve(ROC)was performed in the data of 24 h after admission in group A.The areas under curve(AUC)of HBP combined with NGAL,HBP,NGAL,s Cr,BUN were 0.905,0.851,0.849,0.775,0.659 respectively.When the combined detection of HBP and NGAL > 175.69,the sensitivity was 89.8%,which was significantly higher than other indicators.HBP and NGAL alone also have good sensitivity and specificity.The area under the curve(AUC),sensitivity and specificity of s Cr were lower than those of HBP combined with NGAL,HBP and NGAL,but higher than BUN.(5)Spearman correlation analysis showed that HBP and NGAL were significantly correlated with s Cr,Lac,SOFA score and APACHE II score,except BUN and D dimer.Conclusion:In the absence of AKI,HBP and NGAL have good early predictive value for sepsis-related AKI.HBP combined with NGAL detection is effective in early prediction and diagnosis of sepsis related AKI.The value of HBP and NGAL in early diagnosis of sepsis-related AKI is higher than s Cr,BUN.As an indicator of late renal damage,BUN is of low value to diagnose sepsis-related AKI early.